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FASD is not about having a different looking face which disappears with age, making diagnosis as an adolescent or adult very difficult, or about being somewhat shorter than normal. It is about having deceptively significant brain damage, even in the absence of mental handicap, with enormous implications for function in all adult domains. Its impact on the ability to parent cannot be overstated. People with FASD have many neurobehavioral problems which inter-relate to produce profound problems with accurately processing information and relating to the world around them. Those with the greatest impact on adult functioning are as follow:
whose birthday comes first, even when they know the actual dates for family members. They do not grasp that 7:55 and 8:00 are the same thing for all intents and purposes and are unable to organize their lives according to a time construct without years of specific teaching. They tell time using a digital watch {which has absolutely nothing to do with actual telling time} but are unable to generalize that skill {because it is not concept based} to an analog watch. If they finally master an analog watch with numbers, they will not be able to switch to an analog watch without numbers or only the l2, 3, 6 and 9 indicated. Again, generalization to a very slightly different situation. Add to this the fact they have no sense of time passing, are often truly unable to differentiate between 15 minutes and two hours, perceive early and late very differently than we do and are unaware of how long it takes to accomplish a whole range of tasks and you begin to understand that the expectations for this group of people must be substantially altered. A major mistake made by all systems which deal with adults with FASD is to assume that because they can tell you the time using a digital watch {and since most of us use the same watches} they actually know what time is and how it works. Consider these: How can 60 minutes be one hour if 30 days is one month when 30 is a smaller number than 60, but a month is longer than a day? How can there be 24 hours in one day when there are seven days in one week? How about a.m. and p.m.? How can 7 oclock occur twice in one day? How can the second 7 oclock be at night when it is still light outside? How is the person with FASD supposed to hold all of this in his/her head, at the same time, all of the time?
universally found in FASD, mean that the individual does not because he cannot do well in any of the aforementioned areas of neurobehavioral function which are absolutely inseparable from acceptable social, emotional and behavioral functioning in adult society, no matter how verbal he/she is. The adult with FASD has the appearance of capability without actual, underlying ability. Processing deficits with FASD mean that one cannot use language as a primary means of effective communication with the individual. Consequently, any language and cognition based treatment, intervention or parenting program will fail. Belief that the adult {or child, for that matter} with FASD or one who remains undiagnosed and/or unsuspected is cognitively aware and comprehending of conditions and circumstances and able to make changes based on his/her statements to that fact, will cause one to make critical errors in case planning, case management and case dispensation. This is equally true for social service delivery and the judicial system. In FASD, the brain link between what is asked or required of an individual by a person, place, situation, etc. {information going in} and the action he/she needs to take {activity going out} is defective. Input and output do not equate. The behavior of persons with FASD is not non-compliant behavior; it is non-competent behavior. The behaviors and functions associated with FASD and pre-natal exposure to alcohol are not developmental delays. They do not o away over time, but merely change how they manifest themselves. In fact, these problems become more obvious with increasing age and our demands that all people become self-directed, self-motivated, self-controlled and self-remembered. Any attempt at treatment or intervention for child or adult is unlikely to succeed if we do not keep this information at the forefront of case management. Our lack of tolerance for behavior which falls outside the norm is understandable; our lack of knowledge, training and understanding of what causes this behavior and how one might more effectively and humanely deal with it, is not. The problems as discussed above also impact significantly on children with FASD. The primary difference is that adults do not expect children to think on the same level as adults; they expect children to grow out of what they see as stages and believe that if given enough exposure to the right things whatever they are children will somehow, through osmosis, metamorphosis into functioning people. When that does not happen, however, they typically impose more and more stringent sanction for behavior which is no longer developmentally acceptable. Children with FASD are very difficult to parent under the best of circumstances. They do not process or make sense of their environments any more than adults do. They may also be very hyperactive and have problems paying attention to just about anything. They are highly suggestible, impulse drive, and repeat behaviors which have had negative outcomes over and over. Many are, or quickly become, oppositional and defiant and are highly intolerant of any kind of verbal restriction. Problems with eating and sleeping are common, and many have other significant medical problems as well. Children with FASD have trouble with attachment and bonding even in the absence of abuse, neglect and multiple careviging due to their problems with cause and effect. Attachment is a primary cause and effect relationship and this may be the first place this problem shows up. Multiple care giving can be disastrous for these children. Their problems with social, behavioral and academic school learning are usually significant, even in the absence of mental handicap. Most of them function, by IQ measurement, too high to qualify for more than minimal service in school. Their problems in the school can be overwhelming and frequently blow back on the parent or caregiver. The average child or teen with FASD is very verbal and talks a lot, and is subsequently thought to be brighter and more functional than he/she actually is, leading to the belief that what one sees is behaviour and not organicity. They appear to be the product of poor parenting. It is very easy for systems to fall into the trap of blaming the parent, and while poor parenting and unhealthy environments definitely make things worse, they do not cause the problems to start with. Children and teens with FASD are very tactile and have many problems with inappropriate touching, even in the absence of abuse. They are ready targets for those who would take advantage of them, and frequently the subjects of sexual abuse themselves. A significant proportion of these children will go on to become abusers of other children. Treatment for this group of individuals has not been effective and this lack is cause for very serious concern for their
futures. They are very much at risk for physical abuse in the community at large and in dysfunctional homes due to the chronicity of their various behaviors. They frequently have a very high pain tolerance, and would not necessarily respond to physical abuse as would another child. Injuries and illness which go untreated for longer than would be expected are common in this group of children, even in stable homes, due to this tolerance for discomfort and pain. Children with FASD require early resolution of placement issues, and good, skilled case planning to meet their long term needs. Multiple placements must be avoided. They must have, as an absolute minimum, stable, consistent, caregiving, with a caregiver able to learn the specific skills which are required to maximize functional potential in this group of children. To reach any kind of sustained function within individual parameters of ability, they must have: Constant, total supervision Highly structured, significantly altered physical environments Different communications techniques Mediated learning Labour intensive, time consuming interventions
regardless of age or IQ. Individuals with FASD are not candidates for independent living as adults without extensive, intensive, comprehensive, and continuing supports in place. This is as true for the affected individual with the IQ of 90 as for the individual with an IQ of 68. FASD Support Network http://www.fetalalcohol.com/